PALO ALTO, Calif.--(BUSINESS WIRE)--Conjoined twins Angelica and Angelina Sabuco, joined at the chest and
abdomen, will soon be separate little girls. Lucile Packard Children's
Hospital at Stanford is preparing a November 1 surgery to separate the
two-year-olds, born in the Philippines and now living in San Jose,
Calif. The operation, including six hours of work to cut apart the girls
and two to three hours of reconstruction, is the culmination of several
months of complex planning involving specialists from nearly every part
of the hospital.

"This is a major operation, but we really expect both twins to survive
and to do well," said pediatric surgeon Gary Hartman, MD.

The surgery will be the second separation of conjoined twins performed
at Packard Children's. The first pair was successfully separated in 2007
by a team that Hartman led. The Sabucos’ operation is expected to be
less complex because they share fewer organs.

Angelica and Angelina's mother, Ginady Sabuco, was seven months pregnant
when she learned her twins were conjoined. "I was asking God: why us,
why me?" she said, recalling the day she got the news. It was especially
difficult because her husband Fidel was living and working in San Jose
while Ginady and their son lived in the Philippines.

After joining Fidel in California in late 2010, Angelica and Angelina
were seen at Packard Children's to evaluate their physiology and the
risks of separation.

"I want them to live normally, like other children," said Ginady,
explaining the separation. In addition to the obvious psychosocial
difficulties, remaining conjoined carries risks for the twins' physical
health, such as muscular and skeletal deformities that will worsen with
time.

The radiology team began the assessment by performing extensive imaging.
“CT scans showed that the girls have separate hearts that may touch at
their tips. Their livers are tightly fused together. Their intestines
touch and may be herniated in some spots, but their digestive systems
function separately. Their sternums are joined together; their ribs are
separate,” said radiologist Frandics Chan, MD.

The next step in the twins' preparation, performed in July, was surgery
to insert tissue expanders in four places under their skin. The
expanders are small balloons, gradually inflated with liquid to prompt
growth of extra skin that will be used to repair their separation. Each
of the four expanders (two per child) was inflated weekly; the expanders
are now the size of soft-drink cans.

During the CT scan and the surgical procedures to implant and inflate
the tissue expanders, the anesthesiologists kept a close eye on
responses to sedation and anesthesia. "We've anesthetized them five or
six times now, and they've been very, very stable," said
anesthesiologist Gail Boltz, MD. The girls' circulation is mostly
unshared, which makes anesthesia safer, she added.

Hartman, Chan, Boltz and plastic surgeon Peter Lorenz, MD, have devised
a detailed plan for the surgery, which will involve more than 20
physicians and nurses. They’ve decided where each piece of equipment
will stand, and implemented a color-coded plan for keeping straight
which personnel and tools are assigned to each twin.

Hartman will make the first incisions in the girls' skin and muscle, and
Lorenz will cut through their rib bones. Hartman will separate the
girls' diaphragms and livers, which are firmly adhered along their
longest sides. The liver separation will be the riskiest segment of the
surgery because it is the most likely to cause blood loss. Hartman will
then cut any adhesions between the girls' bowels, and cut the last bit
of skin that joins the sisters. Then, in separate operating rooms, the
reconstruction phase will begin.

Lorenz and his team will rebuild the girls’ chest and abdominal walls.
They will implant a thick, custom-made resorbable plate in each girl's
chest where the sternum should be, and graft bone pieces removed during
the separation onto the plates.

"The plates will dissolve over about a year and a half," Lorenz said.
"That gives the grafted bone plenty of time to fuse, so eventually the
girls will have normal bones and stable chests."

Afterward, the girls will be in intensive care, where they'll recover
for four to five days before being moved to a regular room for another
week or so. Then they'll head home to San Jose to start their lives as
two ordinary little girls. Ginady anticipates that many things will be
easier – she'll finally be able to give the twins breaks from each other
when they argue – but that her sweet daughters will still be basically
themselves.

"Angelica is more talkative and Angelina's a silent type," Ginady said.
The girls love to play "mommy and baby" with each other and listen to
stories and music, she added. They know their colors and can count to
10. When Angelica coughs, Angelina gently pats her back.

Now, Ginady and Fidel are preparing the girls for the same ordinary
challenges any parent anticipates. "I hope that when they grow up, they
go to school, graduate and get stable jobs," Ginady said. "I want them
to have a good future."

It’s a future that’s starting to look very bright. “We think the surgery
will be quite successful,” said Hartman, “and our team is looking
forward to helping Angelica and Angelina live the most normal of lives.”

Celebrating its 20th anniversary in 2011, Lucile Packard Children's
Hospital is annually ranked as one of the nation's best pediatric
hospitals by U.S. News & World Report, and is the only San Francisco Bay
Area children's hospital with programs ranked in the U.S. News Top Ten.
The 311-bed hospital is devoted to the care of children and expectant
mothers, and provides pediatric and obstetric medical and surgical
services in association with the Stanford University School of Medicine.
Packard Children's offers patients locally, regionally and nationally a
full range of health-care programs and services, from preventive and
routine care to the diagnosis and treatment of serious illness and
injury. For more information, visit www.lpch.org.